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University of Rochester Self-Pay Credit Balance Specialist (Off site location) - 228646 in Rochester, New York

Self-Pay Credit Balance Specialist (Off site location) Job ID 228646

Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 008 URMFG Administration


8 AM-4:30 PM


Job Summary:

With latitude for initiative and judgement the Credit Specialist is responsible for working with the Self-Pay department to evaluate outstanding credit balances and determine the best course of action. The Credit Specialist will use tools within the URMC Revenue Cycle systems to verify and generate requests for refunds of overpayments or transfer credits to outstanding patient balances. Credit Specialists are responsible for working credit work queues in URMC Revenue Cycle systems to facilitate the reconciliation of all outstanding credits posted to patient accounts. The position requires excellent organizational and interpersonal skills, attention to detail, and understanding of sound financial controls, strong analytical abilities and the ability to interpret Explanation of Benefits from insurance companies to determine patient financial responsibility.

Serves as a focal point and acts as a resource for answering questions from both Self-Pay Collection Specialists & Patient Services Representatives/Administrative support staff for solving problems regarding difficult or unusual credit balance accounts.

Maintain a detailed knowledge and documentation of policies, procedures, and practices of the University of Rochester's Medical Center (URMC, including SMH, MFG and HH)

The Self-Pay Credit Balance Specialist will represent the department and the University in a professional manner, protecting confidentiality of patient information at all times.

Supervision and Direction Exercised:

The Collection Representative is responsible for performance on assigned tasks, following standard procedures and as directed by the Operations Supervisor and/or Manager.

Machines and Equipment Used:

Standard Office Equipment, including but not limited to: telephone, photocopy machine, adding machine, personal computer, fax/scanner, URMC Revenue Cycle systems, Microsoft Office Suite (Word, Excel, Outlook & Access), GNAV phone monitoring system, and a variety of payer web sites (e.g. MVP, epaces).

Typical Duties:

With general direction of the Self-Pay Supervisor and Manager, with latitude for initiative and judgment, the Credit Specialist responsibilities will include but not be limited to the following:

30% Review and resolve Self-Pay credit balances related to Self-Pay accounts to decrease the amount of credit balances currently in the Self-Pay receivables. This includes but is not limited to:

  • Reviewing patient accounts for URMC Revenue Cycle systems identifying Self-Pay patient credits

  • Analyze to determine the correct allocation of prepayments and overpayments to conclude the correct course of action needed to resolve the credits

  • Interpreting the Explanation of Benefits from the patient's insurance company to determine patient responsibility for services initiating requests for patient refunds

  • Creating appropriate refund spreadsheets to have patient refunds transferred

  • Transfer payments between visits

  • Redistributing funds as needed on accounts showing a credit balance

  • Acts as a Liaison between both front-end & back-end billing reps along with Accounts Payable for workflow processes related to patient credit balances

  • Initiate outgoing calls as needed to customers regarding credit balances

  • Troubleshooting issues as they arise

25% Work reports, Work Lists and WorkQues to help decrease the amount of unbilled Self-Pay visits and ensure timely billing to patients. Assure all hold bills are resolved within 30 days of hold. Examples include but are not limited to:

  • Unbilled Cash Claims

  • Self-Pay plans not final billed

  • Hold Bill Worklists

  • Statement Edits/Holds WQ's

  • Guarantor Research WQ's

  • Credit Balance WQ's

  • Self-Pay> $10,000

  • Faith Based WQ's

  • Budget Plan WQ's

  • Self-Pay Follow Up WQ'

25% Act as backup for the Self Pay Collection Specialist to provide cross coverage which includes but is not limited to:

  • Faithbased

  • Presumptive financial assistance

  • Insurance billing

  • Other recommendations to resolve account

  • Estate Claim verification

  • Collection agency referrals

  • Communication with collection agency accounts

  • Bankruptcy filings and resolution

  • Review of disputes, Settlement offers

20% Receive incoming patient inquires and to complete necessary follow up activities based on the inquiry received from both internal and external customers. Follow up may include but is not limited to:

  • Initiating insurance billing

  • Explaining the balances shown on a patient statement and the processes for further review

  • Advising callers about payment options

  • Working with other areas to determine accuracy of balances shown


Participate in department team staff meetings, educational classes and training

  • Attend monthly department and team staff meetings

  • Stay current on HIPAA guidelines through education and reading monthly emails

  • Participate in educational training such as Strong Commitment ICare and annual In-Service

  • Join Patient Financial Services or Medical Faculty Group committees such as planning Patient Accounts/Medical Faculty Group events

  • Cross Train on team processes to enable assistance and fill in as needed


Associate's degree in Business Administration and 2 years of medical patient accounting or consumer accounting experience or an equivalent combination of education and experience. Ability to use 10 key adding machine and type 25 wpm. Working knowledge of Microsoft Office Suite (Word, Excel, Outlook & Access).

NOTE: This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled